Performances of serum creatinine, C-reactive protein and white blood cell to predict urinary tract infection in febrile children younger than 24 months of age
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Purpose: Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. Methods: This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. Results: Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 103 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. Conclusion: Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings.
Abstract
Purpose: Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. Methods: This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. Results: Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 103 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. Conclusion: Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings.
참고문헌 (21)
- 곽영호, "Utilization of Emergency Department by Children in Korea", Journal of Korean Medical Science, 27(10), pp.1222~1228 (2012), 대한의학회
- Baraff LJ, "Management of fever without source in infants and children", Ann Emerg Med, 36, pp.602~614 (2000)
- Greenhow TL, "Bacteremia in children 3to 36 months old after introduction of conjugated pneumococcal vaccines", Pediatrics, 139, pp.e20162098~ (2017)
- Hoberman A, "Prevalence of urinary tract infection in febrile infants", J Pediatr, 123, pp.17~23 (1993)
- Chang SL, "Pediatric urinary tract infections", Pediatr Clin North Am, 53, pp.379~400 (2006)
- Shaw KN, "Prevalence of urinary tract infection in febrile young children in the emergency department", Pediatrics, 102, pp.e16~ (1998)
- Benador D, "Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis", J Pediatr, 124, pp.17~20 (1994)
- Winberg J, "Commentary : progressive renal damage from infection with or without reflux", J Urol, 148, pp.1733~1734 (1992)
- Ginsburg CM, "Urinary tract infections in young infants", Pediatrics, 69, pp.409~412 (1982)
- Roberts KB, "Urinary tract infection in infants with unexplained fever : a collaborative study", J Pediatr, 103, pp.864~867 (1983)
- Hsiao AL, "Fever in the new millennium : a review of recent studies of markers of serious bacterial infection in febrile children", Curr Opin Pediatr, 17, pp.56~61 (2005)
- Bachur RG, "Predictive model for serious bacterial infections among infants younger than 3 months of age", Pediatrics, 108, pp.311~316 (2001)
- Peltola V, "Comparison of total white blood cell count and serum C-reactive protein levels in confirmed bacterial and viral infections", J Pediatr, 149, pp.721~724 (2006)
- Honkinen O, "Bacteremic urinary tract infection in children", Pediatr Infect Dis J, 19, pp.630~634 (2000)
- Gomez B, "Blood culture and bacteremia predictors in infants less than three months of age with fever without source", Pediatr Infect Dis J, 29, pp.43~47 (2010)
- Shaoul R, "C reactive protein(CRP)as a predictor for true bacteremia in children", Med Sci Monit, 14, pp.CR255~CR261 (2008)
- Sutherland SM, "Acute kidney injury in children", Adv Chronic Kidney Dis, 24, pp.380~387 (2017)
- Averbuch D, "Factors associated with bacteremia in young infants with urinary tract infection", Pediatr Infect Dis J, 33, pp.571~575 (2014)
- Megged O, "Bacteremic vs nonbacteremic urinary tract infection in children", Am J Emerg Med, 35, pp.36~38 (2017)
- Savory DJ, "Reference ranges for serum creatinine in infants, children and adolescents", Ann Clin Biochem, 27, pp.99~101 (1990)
- Drukker A, "Renal aspects of the term and preterm infant : a selective update", Curr Opin Pediatr, 14, pp.175~182 (2002)